They assumed she was demented: Health care at home

Dr. Jack Resnick's story:

I had one 83-year-old patient whose arthritis kept her from moving around, but she loved to talk about her career as a rocket scientist. One day, a well-intentioned neighbor dropped by and called 911 after finding her feverish and dehydrated from diarrhea. My patient had never been treated before at that hospital, and as a Russian immigrant, had no family here for the hospital to contact. She became disoriented; the hospital assumed she was demented and transferred her to a nursing home. It took me two months to track her down and many more to get her home, where, among well-kown attendants and friends, she became lucid again. If she had lived out her days in an institution, she would have cost Medicare a great deal of money, and her life would have been shorter and far less happy.

Patients who are treated at home by a doctor and nursing staff who know them intimately and can be available 24/7 are happier and healthier. This kind of care decreases infections, mistakes and delirium. And it is far more efficient. According to a 2002 study, for the patients treated by the Veterans Affairs' Home Based Primary Care Program, the number of days spent in hospitals and nursing homes was cut by 62% and 88, respectively, and total health care costs dropped 24%.

Thanks to Dr. Resnick, whose article in today's New York Times is excerpted here.

She has taken off her name tag: Hand-washing in hospitals

The WBUR radio station played a story this morning about hospitals' efforts to encourage staff to wash their hands frequently, to prevent hospital acquired infections.

At one Harvard teaching hospital, a nurse observes staff on the Cardiac unit to see who is washing their hands and when. What makes the nurse sure that they won't know they're being watched? Oh, she has taken off her name tag - but still wears the standard blue nurse's uniform and white coat. For ten minutes, she notes who washes their hands. Meanwhile, the Cardiac unit nurses hurry around the unit, probably aware of the one nurse, not from their unit, who isn't hustling around. Surprise! –everyone dutifully uses the hand sanitizer while she watches them. Does this spot-checking really raise compliance with hand-washing rules? Or does it just provide a reassuringly high rate of hand-washing?

A more reliable approach uses unobtrusive measures. Indeed, that ("Unobtrusive Measures") was the title of a book by Eugene Webb et al, written back in 1966. Such unobtrusive or “non-reactive” measures probably give a more honest view. At Beth Israel Deaconess Medical Center in Boston, for example, staff instead measure the volume of hand sanitizer used.

Advice to patient advocates: Bring a bottle of your own hand sanitizer, and keep it on the patient's bedside table as a gentle reminder.

Read another story on blue uniforms and hospital cleanliness.

Thanks to Sacha Pfeiffer for the source story on WBUR today.

And not tell us more to protect ourselves: Three families' victims of MRSA infections

The Story of Ms. A about her husband's treatment in a South Carolina hospital:
My husband was just released after almost two months in the hospital. His hip replacement was infected by MRSA at the hospital and the only way he could get the treatment needed was to remain in the hospital. When we took him back to the hospital with the first signs of infection in his incision he was not in isolation until the tests came back from the lab that it was MRSA. The nurses did not wear gowns and treated him as they did any other patient. Once the tests were known it was a whole different case. Why the hospital didn't see the need to protect all the people the moment a person comes in with a surgical infection is beyond me. I know we will worry about this infection the rest of my husband's life and we know he got it while in the hospital for a routine surgery. In the weeks I went to the hospital to visit my husband, it was scary how many isolation boxes were hanging on patient doors on the 9th floor. Even on the 3rd floor where I walked to get to the parking garage, there were lots of boxes on doors. The bills that have started coming in since we started working with the hospital two months ago are beyond what any regular person can pay. If the hospitals are the cause of spreading this infection, they should have to treat the victims for free. Good luck to Ms. Diane Parker in taking this to a higher power to stop this infection from affecting other families [by organizing a coalition in South Carolina to reduce hospital infections]. 2/3/09


The Story of Ms. B about her father's treatment in the same South Carolina hospital:
My family had the same experience with that hospital. My dad contracted MRSA after a back surgery. He battled it for a year before sadly we lost him to this totally preventable infection. There were isolation boxes on the 9th floor, but I never saw anyone take out the gowns, gloves, or masks that were in there. The doctor didn't wash his hands when coming in or leaving the room. Neither the doctors nor nurses told the family that we should be using the gowns and gloves. It was a custodial staff member that alerted us. After asking many questions, we finally had a name for the infection and realized that our dad was in for a rough ride. Although I am not a fan of lawsuits, it seems the only thing that talks in this country is money. Hopefully, an attorney will step forward and be brave enough to take a case like this. I have been unable to find one to help me hold the hospital accountable for an unnecessary death.


Crickett's story about her mother's treatment in another South Carolina hospital:
My family experienced the same thing also. Only my mother died 34 days after contacted HAMRSA , thru an intravenous [IV] line in the hospital. She had surgery to remove an area of her arm 1 inch wide and 6 inches long of all veins and tendons. On top of that was sent home with home health to show me how to care for the wound which was left open, not stitched up. She was only treated 4 days with vancomycin, which is one of the only drugs to fight infection. And sent home on bactrim. We took her to another hospital, where she was diagnosed with Septic MRSA. Why didn't the hospital tell us she was going to die, and not tell us more about how to protect ourselves from this dangerous infection?!


On Feb. 4, the South Carolina Hospital Association, Health Sciences South Carolina and Premier Healthcare Alliance announced a major statewide effort to get rid of preventable infections. They have formed the South Carolina Healthcare Quality Trust. This group is to figure out the problems and find the solutions.

Advice to people with a family member in the hospital: Ask the nurse if the hospital participates in a multi-hospital effort to prevent hospital infections.

Read another story of a serious hospital infection in a South Carolina hospital.

Thanks to Dawndy Mercer Plank for the source story, and to Helen Haskell for publicizing this.

Theoretically a totally preventable disease: MRSA infections

A high school student in Bedford, Virginia who was hospitalized for more than a week with an antibiotic-resistant staph infection, has died. After a student protest, officials shut down 21 schools for cleaning to keep the illness from spreading. Ashton Bonds, 17, a senior at Staunton River High School, died Monday after being diagnosed with Methicillin-resistant Staphylococcus aureus, or MRSA, his mother said.

"I want people to know how sick it made my son," Veronica Bonds said.

MRSA is a strain of staph bacteria that does not respond to penicillin and related antibiotics but can be treated with other drugs. The infection can be spread by skin-to-skin contact or sharing an item used by an infected person, particularly one with an open wound.

Ashton went to the hospital on Oct. 4 after complaining of pain in his side, his mother said. He was sent home after doctors ruled out appendicitis, but was readmitted three days later and taken to another hospital. Last week doctors diagnosed him with a MRSA infection that had quickly spread to his kidneys, liver, lungs and the muscles around his heart. Early Thursday morning, Ashton had to be sedated and put on a ventilator. He was about to undergo surgery to drain the infection from his lungs when doctors detected a blood clot near his heart. But the clot was inoperable.

Ashton is one of 19,000 people who die each year from infections by drug-resistant bacteria. The vast majority – about 85% - of invasive MRSA infections are associated with healthcare treatment, e.g., in a hospital or nursing home, according to a study published today in the Journal of the American Medical Association.

Some hospital systems, e.g., Evanston Northwestern Healthcare, have dramatically reduced their rate of MRSA infections. Dr. Lance Peterson, an epidemiologist at ENH, said, "MRSA is theoretically a totally preventable disease."

Advice to hospitalized patients: Put up a sign near your bed asking your doctors and nurses to wash their hands.

Read another drug-resistant infection story, or read more from today’s Associated Press stories, or the New York Times article by Kevin Sack.

Scrub those scrubs!: A professional appearance with little fuss

Scrubs, of course, are those distinctive, simple, usually blue, shirts and pants that doctors and nurses wear while in the operating room.

Wearing scrubs became a badge of the profession, like wearing a white coat or carrying a stethoscope. Since then, it has become a fashion statement to wear scrubs outside, e.g., while shopping in the supermarket. Now it connotes high tech, medical science, good health, saving lives, and looking like "Dr. Meredith Grey" or "Dr. Preston Burke."

Scrubs are characteristically of cotton. Now there are also scrubs made of blends of polyester and cotton to maintain "a wrinkle-free professional looking appearance with little fuss."

They’ve become their opposite. I hung out on Longwood Avenue in Boston, near several Harvard teaching hospitals, with two Australian friends, as they laughed uncontrollably every time they’d see a doctor or nurse on the street in their scrubs. Then I got it: An urban street is far from sterile. If scrubs mean, "We’re taking special care to be sterile," then why are clinicians wearing them on the street? Just because it’s easy, to look cool, and announce their status (and announce they’re not keeping them sterile)? Will they wear the same scrubs in the O.R.?

Do you get the joke? -And did you realize the joke’s on us?

Advice: If you see your doctor or nurse on the street in scrubs, smile, but don’t laugh. And buy some for yourself—they really are comfortable, and look cool.

Read a patient safety joke.

Dis-Infecting Hospitals: A Role for Citizens

State Senator Richard T. Moore, the chairman of the Massachusetts legislature’ Health Care Financing Committee, filed legislation yesterday that eventually would require health officials to make public the infection rates for individual hospitals. State health officials said public disclosure probably would be part of any new reporting requirements placed on hospitals. Sen. Moore said public reporting will give hospitals added incentive to improve their infection rates.

Hospitals can indeed greatly cut their infection rates. Last month, Beth Israel Deaconess Medical Center president Paul Levy posted his hospital's rates for central line-related infections, in part to spur other hospitals to be more transparent about their quality of care. Bacteria on the tubing can flow quickly through the bloodstream and to major organs, making these infections of particular concern. BIDMC staff have cut the central line infection rate in half from its rate of 3 central line infections per 1,000 patient days a year and a half ago.

Advice: Tell your friends in Massachusetts to support this bill.

Read a patient's story, or read more on this from Liz Kowalczyk's article in today's Boston Globe.

He'll Be Back Playing Football in the Fall: Surgical error

His mother says about her son Jimmy, "His whole life was in a team uniform," first baseball at age 4 and then football at age 7. And he was good--he'd won his local Punt, Pass and Kick competition as a child. Then at age 15 he had a bicycle accident that required outpatient knee surgery. He was told he'd be back on the football field in the fall. But he developed a staph infection, probably from a dirty surgical instrument or doctor or nurse who didn't wash their hands thoroughly enough.

MRSA (Methicillin Resistant Staphylococcus Aureus) and other bacteria had invaded his blood, bones and joints. His treatment has involved massive amounts of Vancomycin and other antibiotics, physical therapy and multiple operations. He requires bone grafts from his hip and heel to replace the lost bone damaged by infection. Now Jimmy Toolen can't go to school, and needs a cane, walker or wheelchair to get around. The hospital infection has also damaged his mother and father's health, and has wrecked them financially.

His mother Lisa Toolen has worked hard to support a state law requiring the disclosure of hospital infection rates in South Carolina. Efforts like hers have persuaded 16 states to pass some form of public reporting law. She has told her story to the Consumer Reports organization, which is collecting these stories.

Advice for parents: Tell your story loud and long, here and elsewhere. Join with other victims' families to get laws passed to reduce hospital infection rates.

Read more in articles by Robert Kittle and David Hutchins.